Depression
Which highest-priority outcome would the nurse add to the plan of care for a depressed client?
1.The client will promise to remain safe.
2.The client will discuss feelings with staff and family by day 3.
3.The client will establish a trusting relationship with the nurse.
4.The client will not harm self during hospital stay.
4. The nurse’s highest priority should be that the client will not harm self during the hospital stay. Client safety should always be the nurse’s highest priority.
A highly agitated client paces the unit and states, “I could buy and sell this place.” The client’s mood fluctuates from fits of laughter to outbursts of anger. Which chart entry would the nurse document for this client’s behavior?
1. “Rates mood 8/10. Exhibiting looseness of association. Euphoric.”
2. “Mood irritability. Exhibiting magical thinking. Nervousness.”
3. “Blunted affect. Exhibiting delusions of reference. Hyperactive.”
4. “Agitated and pacing. Exhibiting grandiosity. Mood labile.”
4. Based on the client’s behaviors and statements, the nurse would chart, “Agitated and pacing. Exhibiting grandiosity. Mood labile.” The client is exhibiting mood labile from fits of laughter to outbursts of anger. Grandiosity refers to the attitude that one’s abilities are better than everyone else’s (I could buy and sell this place).
Which information would a nurse include in client teaching about social anxiety disorder?
1.Obsessions are the underlying reason for clients to avoid social situations.
2.These people avoid social interactions because of a perceived physical flaw.
3.Individuals with social anxiety disorder avoid performing in front of others.
4.People with this disorder avoid social gatherings because of fear of separation.
3. Clients diagnosed with social anxiety disorder have a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Which outcome would the nurse add to the plan of care for an inpatient client diagnosed with somatic symptom disorder (SSD)?
1.The client will admit to fabricating physical symptoms to gain benefits by day 3.
2.The client will list three potential adaptive coping strategies to deal with stress by day 2.
3.The client will identify the connection between function loss and severe stress by day 3.
4.The client will maintain a sense of reality during stressful situations by day 4.
The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day 2.
(In SSD, client is experiencing real sx, not faking. They need to make connection between physical sx and psychological problems. This client does not lose touch w/ reality).
The client with major depressive episode is experiencing command hallucination for self-harm. Which intervention should be the nurse’s priority at this time?
1.Obtaining an order for locked seclusion until client is no longer suicidal
2.Conducting 15-minute checks to ensure safety
3.Placing the client on one-to-one observation while continuing to monitor suicidal ideations
4.Encouraging client to express feelings related to suicide
3. The nurse’s priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide.
The client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 2 nights and a 13 lb. (5.9 kg.) weight loss over the past 2 weeks. Which nursing diagnosis is priority?
1.Knowledge deficit R/T bipolar disorder
2.Imbalanced nutrition: less than body requirements R/T hyperactivity
3.Risk for suicide R/T powerlessness
4.Altered sleep patterns R/T mania
2. The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity. Because of the client’s rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and physical health.
Which guideline should the nurse use to help differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?
1.GAD is acute in nature, and panic disorder is chronic.
2.Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders.
3.Depression is a common symptom in GAD and rare in panic disorder.
4.Depersonalization is absent in GAD but is commonly seen in panic disorder.
4. The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.
The nurse discovers the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder?
1.Illness anxiety disorder
2.Factitious disorder
3.Functional neurological symptom disorder
4.Depersonalization-derealization disorder
2. Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill to receive emotional care and support commonly associated with the role of client. Individuals become very inventive in their quest to produce symptoms.
The nurse assesses a client with major depressive disorder. Which assessment finding would the nurse observe?
1.Sadness subsides quickly
2.Promiscuous behaviors
3.Unable to feel any pleasure
4.Excessive spending sprees
3. The client being unable to feel any pleasure meets the diagnosis requirements of major depressive disorder.
A client has been diagnosed with major depressive episode. After treatment with an antidepressant, the client exhibits pressured speech and flight of ideas. Based on this symptom change, which information should the nurse share with the health-care provider?
1.Ask to increase the dosage of the antidepressant.
2.Ask that the client be reevaluated.
3.Ask to order benztropine (Cogentin) for the extrapyramidal symptoms.
4.Ask that another class of antidepressants be used.
2. The nurse would ask the health-care provider to reevaluate the client because the client switched from depression to mania. Antidepressants carry as high as a 40% risk of potentially triggering a switch from depression to mania in individuals with bipolar disorder. A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis.
The nursing instructor is teaching about medications used to treat clients diagnosed with panic disorder. Which student statement indicates teaching has been effective?
1.“Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder.”
2.“Clonidine (Catapres) is used off-label in long-term treatment of panic disorder.”
3.“Atenolol (Tenormin) can be used in low doses to relieve symptoms of panic attacks.”
4.“Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks.”
1. The student indicates learning has occurred when the student states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and its related symptoms.
(Buspirone has a 10- to 14-day delay in alleviating symptoms)
The nurse is caring for a client diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client?
1.To recover memories while improving thinking patterns
2.To prevent social isolation
3.To decrease anxiety and need for secondary gain
4.To collaborate among subpersonalities to improve functioning
4. The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among subpersonalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client’s functioning and potential.
Which characteristic would help a nurse distinguish between dysthymia and major depressive disorder (MDD)?
1.Dysthymia is associated with the menstrual cycle.
2.Dysthymia is a chronically depressed mood.
3.MDD lasts for at least 2 years.
4.MDD does not have delusions or hallucinations.
2. Dysthymia is somewhat milder than MDD, but the essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years.
The client taking lithium carbonate (Lithobid) presents to an emergency department with a temperature of 101°F (38°C), severe diarrhea, blurred vision, and tinnitus. The nurse knows that these symptoms indicate which of the following?
1.Spending time outdoors without sunblock.
2.Antipsychotic withdrawal syndrome.
3.Development of neutropenia.
4.Lithium carbonate toxicity.
4. The nurse should interpret that the client’s symptoms indicate lithium carbonate toxicity. The signs and symptoms of toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure therapeutic blood levels.
A student questions the difference between Social Anxiety Disorder (SAD) and other anxiety disorders. The nurse identifies which of the following as the chief factor distinguishing SAD from others?
1.SAD is characterized by a fear of being in open spaces.
2.SAD is characterized by a fear of being negatively evaluated by others.
3.SAD is characterized by a fear of situations that could conceivably cause harm.
4.SAD is characterized by the presence of obsessions or compulsions that interfere with functioning.
2. SAD is characterized by avoidance of social situations and is primarily driven by a fear of being negatively evaluated by others with the expectation that negative evaluation by others will lead to embarrassment and shame.
Which are examples of primary and secondary gains that a client diagnosed with SSD: predominately pain, may experience?
1.Primary: chooses to seek a new health-care provider; Secondary: euphoric feeling from new medications
2.Primary: euphoric feeling from new medications; Secondary: chooses to seek a new health-care provider
3.Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion
4.Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards
4. The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion) and that secondary gains are those in which the client receives emotional support or attention (get-well cards).
The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.)
1.“I’ll have to let my surgeon know about this medication before I have my cholecystectomy.”
2.“I guess I will have to give up my glass of red wine with dinner.”
3.“I’ll have to be very careful about reading food labels.”
4.“I’m going to drink my caffeinated coffee in the morning.”
5.“I’ll be sure not to stop this medication abruptly.”
ANS: 1, 2, 3, 5
1. The nurse should evaluate successful teaching when the client will tell the surgeon about taking this medication. The client needs to tell other physicians and surgeons about taking MAOIs because of the risk of drug interactions.
2. The nurse should evaluate that teaching has been successful when the client states that MAOI should not be taken in conjunction with the use of alcohol. This action will prevent a hypertensive crisis.
3. The nurse should evaluate that teaching has been successful when the client states that reading food labels is necessary. This will prevent consuming foods high in tyramine while taking MAOI to prevent a hypertensive crisis.
4. The nurse should evaluate that teaching has not been successful when the client is going to drink coffee. The client will need to give up caffeinated coffee with this medication to prevent hypertensive crisis.
5. The nurse should evaluate that teaching has been successful when the client will not stop the medication abruptly. MAOIs should not be stopped abruptly.
____________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech.
MANIA! Mania can occur as part of the psychiatric disorder bipolar disorder, as part of some other medical conditions, or in response to some substances.
The client has been diagnosed with generalized anxiety disorder (GAD). Which symptoms would the nurse observe upon assessment? (Select all that apply.)
1.Muscle tension
2.Paresthesia
3.Hyperventilation
4.Restlessness
5.Procrastination
ANS: 1, 4, 5
The nurse should expect that a client diagnosed with GAD would experience muscle tension from the worry and anxiety. Also, restlessness from the anxiety and worry. Anxiety and worry often result in procrastination in behavior or decision-making, and the individual repeatedly seeks reassurance from others.
A client reports feeling like objects in the environment are altered in size and shape and reports a sense of detachment from the environment. The client’s father asks, “What is wrong with my son?” Which response(s) by the nurse are correct? (Select all that apply.)
1. “Your son is exhibiting symptoms of derealization.”
2. “Your son is exhibiting symptoms of depersonalization.”
3. “Your son’s perceptual experience accompanies many different psychiatric illnesses.”
4. Your son’s perceptual disturbance is uncommon.”
5. “Your son’s perceptual experience may be causing him anxiety.”
ANS: 1, 3, 5
The client is exhibiting symptoms of derealization, characterized by a sense of detachment from the environment.
This is a common perceptual experience in many different psychiatric illnesses, including psychosis, anxiety disorders, and trauma or related disorders.
Very often, this symptom causes or contributes to the client’s symptomatic experience of anxiety.